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Month: March 2012

Science has done it again. Dirty pigs are healthier pigs. It has been proven. Don’t ask how, because it involved a lot of fetal pigs (which makes my undergraduate pig dissecting PTSD flare up), poop and blood. But it also involved a lot of wallowing and I am ALL about science that proves that wallowing is good for you.

Sure, the title – Environmentally-acquired bacteria influence microbial diversity and natural innate immune responses at gut surfaces – scintillating as it is, might not immediately strike you as a defense of all that is good about being dirty. But pull up a chair and consider the dirty details.

Gut immunologists took baby pigs and sent them outside, inside or into a kind of antibiotic-laced biologic bubble. The guts of the outdoor, mud-wallowing pigs were full of healthier bacteria than the indoor pig guts. Not only was there more of the good stuff in outdoor beasts, there was also less harmful bacteria in the chute. Most cool and interesting, though, is that the bacterial composition of the piggies’ guts influenced the expression of immunologic genes: pristine, white-glove pork expressed more inflammatory genes and other icky inflammatory stuff.

I know what you’re thinking. Pigs aren’t human, Dr. Rentel. True. Based on this study I’m not going to build a heated pigsty with a giant HDTV for me and my kids in the backyard. There is, however, a growing, stinking, microbial-filled gooey heap of evidence that human interaction with bacteria is good. Why does the prevalence of autoimmune diseases and allergies keep going up? This study gives some very direct, powerful evidence as to how the cascade of autoimmune badness gets started. Okay, yes, in pigs, but pigs are a whole lot like us.

As my favorite infectious disease specialist in the whole wide world (Dr. George Gianakopoulos) used to say, “Nature abhors a vacuum. Kill the good bacteria and welcome in the bad.” I’m not saying you should order dirt for take-out tonight. But skipping the whole-body antimicrobial gel bath every day might not be a bad idea.

This week marks the 10th Annual National LGBT Health Awareness Week. You may think “What does being Lesbian, Gay, Bisexual or Transgender have to do with my health?” Well, as a matter of fact – a lot!

There are higher rates of smoking, illicit drug usage and binge drinking among LGBT people

Eating disorders are more prevalent in gay and bisexual men compared to straight men

There are higher rates of stress disorders, addictions and suicide attempts by youth in the LGBT population

Rates of Intimate Partner Violence are equivalent to heterosexuals but the resources for help are less accessible, especially in rural and non-urban areas

STI (sexually transmitted infection) rates are much higher, especially in younger gay men and African American gay men

LGBT people are more likely to suffer verbal abuse by their peers

It can be more difficult to find health care providers willing to work with transgender patients

In addition to all of the above risk factors, many LGBT people find it hard to come out to their health care providers. Some may still be seeing the same family doctor they grew up with – and that their parents still see! – and fear that the doctor may be judgmental of their sexuality. Others find it hard to trust a new health care provider out of fear that they will be treated differently.

Well, your health care provider should treat you differently! Your sexuality is not the defining factor of your character, but it certainly is an important part of your health so you should share that information with your health care providers. Ohio State has many resources available to help LGBT students live a healthy life.

All of the health care providers at Student Health Services are sensitive to LGBT health issues and many have a specific interest in LGBT health.

The Office of Student Life has a program called B.A.R.T. (Bias Assessment and Response Team), which allows students, staff, and faculty to anonymously or confidentially report incidences of abuse or crimes based on a bias against the victim.

Yes. In general, hormonal birth control methods that contain both estrogen and a progestin (birth control pills, the patch, NuvaRing) decrease the number of days of bleeding and the amount of blood women lose each cycle. Since these methods all have varying levels of estrogen and progesterone in them, a change from one kind of birth control to another can also change the days and amount of flow.

During a normal menstrual cycle, hormones cause the uterus to build up a thick lining with a lot of blood vessels called the endometrium to create a welcoming environment for a fertilized egg to attach. If conception doesn’t happen, the hormone levels drop, the blood vessels shrink and the endometrium sloughs off. Voila – you have a period! Hormonal birth control causes the endometrial lining to be thinner than normal, so there is less to shed each month. In fact, there may be no fresh blood at all. A period could be just a drop of blood, or a brown smudge.

On the other hand, if you are using a birth control method that contains only a progestin and no estrogen (Depo Provera, Nexplanon implant, Mirena IUD, or “mini-pill”) you are more likely to experience irregular bleeding. Many women experience either an increased number of days of light bleeding or no bleeding at all.

It’s a good idea to check in with your health care provider after your first 3 months on the pill to make sure everything is going OK. If your pattern of bleeding concerns you be sure to see her to rule out the possibility of pregnancy, infection or other medical conditions. Remember, not all bleeding can be blamed on birth control!

If you have any questions or concerns about birth control, the clinical staff of our Women’s Services Department is always happy to see you!

Long A: Depo Provera (“Depo,” “the Shot”) is one of a family of progesterone-only contraceptive products. It is an injectable product-a shot. It is a really effective and convenient way to prevent pregnancy; you only have to think about it 4 times a year and in clinical studies, less than 1% of women get pregnant on it. (In real life, about 5% get pregnant – probably because in real-life some women didn’t get their shot on time.)

There are a couple of downsides to Depo Provera. It is, as noted, a shot. Ouch. It can be expensive if your insurance doesn’t cover contraception. (On the other hand, a baby is a whole lot more expensive!) Like most hormonal contraceptive products, some women will feel a little bit pregnant-bloated, queasy, weight changes, headachy-on Depo, especially at first. Some women gain up to 5-10 pounds on Depo, although most gain only 3-5 pounds. (While 3-5 pounds ain’t nothin’ it’s still a whole lot less than a baby!) It can interfere with bone mineralization, making osteoporosis and fractures slightly more likely down the road.

There are some big upsides, though, too. Periods often stop, although for the first few weeks/months of use there can be some irregular spotting. (Are all you men out there going, yuck, gross, icky?) The incidence of pelvic inflammatory disease, endometrial hyperplasia, endometrial cancer, and endometriosis pain are all decreased. And there are also specific medical conditions which benefit from Depo-Provera:

Because the metabolism of Depo Provera doesn’t change with anti-seizure medicine, it’s a good choice for women with seizure disorders.

Women with sickle cell disease appear to have fewer pain crises while on depo.

Peri-menopausal vasomotor symptoms (the dreaded “hot flashes“) tend to be better compared to birth control that has estrogen in it.

Depo Provera does not appear to increase the risk of liver, breast, or ovarian cancers. It probably does not affect blood pressure or coagulation, making it sometimes an okay choice for women who have had high blood pressure, heart disease, or a history of blood clots. It unfortunately does not protect women from sexually transmitted infections so you still need to get a condom on your partner.

So to finally answer your question, Depo Provera does not permanently impair your ability to get pregnant. It can, though, take a few months off the medication (sometimes up to 18) to become pregnant.

And by the way, if you are pregnant and accidentally get the shot, there is no evidence to suggest that any harm will come to the baby as a result of the medicine.

Student Health Services sees a lot of students with plans to travel internationally, either as part of one of the many OSU Study Abroad opportunities, other travel associated with academic programs, or recreational travel. Before you grab that passport and head for the airport, here are some healthy pointers:

Plan ahead – Most students plan for months or even years to get ready for international travel. Don’t forget to include health matters in those plans. Some vaccines are given in series over months, so start those early.

Talk to your health care provider about your trip – This is especially important for those students with chronic illnesses or prescriptions that they plan to continue while traveling.

Do your health insurance homework – Are you covered in Caracas? What is your deductible in Denmark? Is there a co-pay for Tetracycline in Timbuktu? Find out how your travel plans will impact your coverage.

Visit a travel expert – Our Student Health Services travel providers are ready to address your needs comprehensively, and offer an extensive selection of travel vaccines and medications. If you plan to visit someone else, make sure they are up to date on the changing health situations around the globe. (BTW, SHS is an Ohio Department of Health-certified Yellow Fever Vaccine clinic)

Be Patient! – Travel visits usually take a bit longer than a typical visit to the doctor, as each visit includes a thorough review of your health history, a discussion of your destination country’s or countries’ current health and safety conditions, and orders for all necessary medications and shots. Many students also start their vaccines at that same visit, so we would expect that you would be with us 40-60 minutes at a minimum. (All vaccines are recorded on an official International Vaccine Certificate for your convenience.)

Keep in mind, disease exposures can occur on a 3 month excursion across a continent or during a 5 day trip to a beach resort. So, come see us before you order your Spring Break airline tickets. Reduce the risk of having your trip to Cabo result in spending the first weeks of Spring Quarter sick from a preventable illness.

We spend a lot of time helping students figure out how to avoid getting pregnant, but there are a fair number of Lady Buckeyes out there who are ready to start planning a family, and they need good information too! So in the spirit of fair play, here is a checklist of things you should do if you’re planning to get pregnant.

Be sure your vaccinations are up to date, especially MMR (Measles, Mumps, and Rubella), Varicella (chickenpox) and Hepatitis B. Your unborn child can be harmed if you contract these infections while you are pregnant. These vaccines are part of the standard childhood immunization schedule, but you can make an appointment with Student Health Preventive Medicine to check your immunity if you aren’t sure whether you received them.

If you haven’t received a tetanus shot within the last 10 years, you should receive the Tdap (Tetanus-Diptheria-Pertussis) vaccine.

If you have any chronic health conditions, be sure to see your primary health care provider so she can review your medications and make sure your conditions are under optimal control.

Schedule a GYN exam. This will give your health care provider a chance to assess your overall health status, screen you for sexually transmitted infections, review your health and family history, and give you proper guidance for pregnancy planning.

Stop your birth control at least 3 months before you are planning to get pregnant. If you’ve been taking birth control pills, a pill-free break will allow you to go through several normal cycles before you conceive, which will make it easier to determine when ovulation occurred and to accurately estimate your due date. Your fertility may return to normal as early as two weeks after you stop taking the pill. If you are using Depo Provera, it may take several months for fertility to return.

Basal Body Temperature charting is a very useful tool for couples trying to conceive because of its ability to confirm ovulation. You need to use a basal thermometer, which is different than a regular thermometer. You can get them at most pharmacies.

Quit smoking, alcohol and recreation drugs.

Try to reach a healthy weight. Being overweight or underweight can make things more difficult before and during pregnancy. Ideally, your Body Mass Index (BMI) should be between 19 and 25. Check out this BMI calculator to figure out your BMI.

Try to eat a healthy and balanced diet. If you are a vegetarian or vegan, you may need to add a Vitamin B12 supplement to your diet. Be sure to discuss this with your healthcare provider.

Start an exercise program now, even if it is just walking every day. You should aim for a goal of 150 minutes of moderate intensity exercise per week.

Start taking a prenatal vitamin that contains 400 mcg of Folic Acid at least 3 months before you are planning to get pregnant. Folic acid deficiency can cause birth defects. These vitamins are available over-the-counter so you don’t need a prescription for them.

Avoid consuming a lot of fish, especially swordfish, tilefish, king mackerel and shark. These fish contain methyl mercury, which can harm the nervous system of your unborn child. You can eat up to 12 ounces a week of a variety of fish and shellfish, such as shrimp, canned light tuna, salmon, Pollock and catfish. The FDA has a great website that tells you what foods to avoid during pregnancy.

Avoid raw and undercooked meat, unwashed fruits and vegetables, and dirty cat-litter boxes. All of these things can be infected with Toxoplasmosis gondii, which is harmful to your unborn baby. If you don’t have a cat, don’t get one. If you do, have someone else change the litter box, or at the very least wear disposable gloves and wash your hands thoroughly with soap and water immediately afterwards. Be sure to wear gloves when gardening.

If you or your partner work in an environment where you are exposed to X-rays, lead, mercury or chemicals, you should take extra precautions at work or explore options for moving to a different area. You can check out Ohio State’s Environment Health & Safety office if you have any questions about safety or hazards in your work place.

Is there anything that can be done for ADD besides taking medications? I’m really not a fan of jumping right into medication if I can do other things to help first, especially because of the cost.

Excellent question!

The key to managing ADD, whether you’re taking medication or not, is developing good time management and organizational skills. I know – that’s like saying, “just eat right” or “cut down on your stress” – but there are some concrete steps you can take to achieve this goal:

Make lists and schedules to keep track of what you need to achieve – and stick to them

Keep a large calendar with important deadlines in a central location in your apartment or dorm

Keep your desk clutter-free

If you’re studying in a library, sit in a carrel-style desk or a room with no windows

Break down large projects into manageable chunks, and assign each one its own deadline

Throw your cell phone in Mirror Lake!

OK, I was speaking metaphorically on that last one, but you know what I mean. You MUST turn off the texts, tweets, tumbls, check-ins, youtubes, IM’s, status updates, skypes and gmails when you’re studying if you hope to get anything done.

Some research has shown that Omega-3 fatty acids and drinking green tea can improve attention and memory. The CogMed Working Memory Training program has also been shown to be effective in improving attention and memory, but it is pretty expensive.

Luckly you have some really good – and free! – services right here on campus that can help.

Psychotherapy and coaching can be very useful in managing ADD by helping you to learn behavioral strategies, identify and eliminate avoidant coping strategies, and establish good self-care. As an enrolled OSU student, you can get free individual psychotherapy services from Counseling & Consultation Service (CCS).

CCS also offers a support group called Living and Succeeding with ADHD that “provides a supportive atmosphere in which students with diagnosed attention and concentration difficulties can ‘pool their resources’ to cooperatively help each other learn and utilize new strategies for setting goals and achieving objectives.” The group is facilitated by Robert M. Bennett; you can call 614-292-5766 or email Rob at bennett.455@osu.edu to learn more about the group.

The Office of Disability Services (ODS) assists students with academic services and accommodations, and their counselors are available to meet with students on a one-to-one basis for assistance with time management, study strategies, and advocacy skills. ODS doesn’t provide diagnostic testing for students who suspect that they have a ADD or other learning disabilities, but students can speak to a disability counselor who will make referrals to other resources within and outside of the OSU community.

If you have any questions about whether or not you may have ADD, you can always make an appointment to see one of our doctors at Student Health. We can evaluate your symptoms, refer you for appropriate testing and help you manage your symptoms, with medication or without!

Bong Joo Hwang, Ph.D.Counseling and Consultation ServiceThe Ohio State University

I am currently taking IGF (Insulin-like Growth Factor) derived from deer antler velvet as a nutritional supplement. Will the usage of IGF in a healthy person cause hyperthyroid problems or any other health issues?

This is an interesting question – actually two interesting questions: can taking deer antler velvet hurt you, and can taking IGF hurt you?

First, the following disclaimer: Products that are sold as supplements (as opposed to medications) are not regulated by the Food and Drug Administration so they are not tested for safety, efficacy or standardization. In other words, when you buy a supplement, there is no guarantee that what is in the bottle has been tested to see if it even contains the ingredient in question, let alone whether the ingredient actually does what it claims to. (That’s not a value judgment, just the facts.)

With the fine print out of the way, here’s what I can tell you:

Deer antler velvet is used for its purported ability to raise testosterone levels to treat decreased libido (low sex drive), infertility, and erectile dysfunction in men. It is used in combination with other herbs to treat sexual dysfunction and hormonal dysfunction in men and women. It is used to treat conditions resulting from deficient kidneys. Some people use it because of its reputed benefit as an aphrodisiac and muscle strength enhancer. It is also sometimes prescribed to help alleviate withdrawal symptoms in the treatment of morphine addiction.

All of the studies I found in the medical literature that looked at the use of deer antler velvet were done on rats – NOT humans – so it is impossible to rule out any adverse effects for sure. I couldn’t find much information about whether or not it causes thyroid problems.

Unfortunately, the potential problems with IGF would seem to negate any of these theoretical benefits. It has been shown that improper use of hormones such as dehydroepiandrosterone (DHEA), androstenedione, and human growth hormone may increase the risk for development of prostate cancer or promote the growth of existing prostate cancer by raising IGF-1 levels. Therefore, men who are taking supplements with IGF in it (or those that raise IGF levels) could theoretically be putting themselves at an increased risk for prostate cancer. Again, it hasn’t been rigorously studied so it’s impossible to know for sure, but if you have any risk factors for prostate cancer, it’s probably best to avoid taking this supplement.

Side effects of IGF supplementation most commonly occurred in elderly patients and involved kidney problems, which would again nullify some of the purported benefits of deer antler velvet supplementation.

So the best answer I can give you is… I have no idea. No one really does. But if you ever have questions about any medications that you are taking, feel free to come in and talk to our pharmacy staff. And of course, if you have any specific health concerns, you can always make an appointment to see one of our health care providers.

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